There are many different symptoms that a patient can complain of that they relate to an ear (otological) involvement. Some of the common complaints that we hear are:

• "I have ear pain."
• Tinnitis - "There is ringing or noises in my ear."
• "Fullness in the ear."
• "My ear feels plugged."
• " Water in my ear."
• "Cracking in my ear."
• Autophonia - "I can hear myself talking."

It is certainly possible that the ear structure itself is the culprit in the production of some of these symptoms however if all possible otological causes have been ruled out by a physician, one must suspect a CRANIOCERVICAL DISORDER.  In fact many ear symptoms are referred from the cranial or cervical regions.

A very common scenario that we see is a patient going from their family physician to otolaryngologist (ENT’s) to even neurologists for help with their ear pain.  Most are told that the structure of the ear is fine and they do not have an infection.  These patients are then sent away without an explanation of their pain or a treatment option.

At Rehabilitex we may be able to help you as we have many others in this situation.  The program begins with a comprehensive examination to determine if the ear pain/symptoms can be mechanically (somatically) modulated, i.e. can a specific movement, palpation or muscle contraction produce or reduce the patient’s familiar symptom.   The ability to mechanically influence the symptom is a key component in the decision to treat or not treat the patient.  We will be able to determine this on the first visit and let the patient know if we can help them.

On the initial physical therapy evaluation of non-otologic (ear) symptoms...... YOU can expect:

Assessment of the following areas of the neck can send pain to the ear:

• The Sternocleidomastoid muscle (SCM).This muscle is located in the front and side of your neck.  When the SCM has abnormal muscle tone it will refer pain directly to the ear.  It can also send pain to the forehead and back of the head.  Interestingly, it can also give a sensation of dizziness when moving your head.
• The first and second cervical joints (C1-C2) and the corresponding Muscles.  These joints and muscles commonly refer pain to the head and have overlapping sensation to the ear.
• The Craniomandibular Region, also known as the Temporomandibular Joint (TMJ).  The actual location of the TMJ is directly in front of the ear so it is easy to see that TMJ pain can be mistaken for ear pain.  The muscles that control the TMJ, called the muscles of mastication, can refer pain that is felt “deep in the ear” when they have abnormal muscle tone.
• Eustachian Tube (ET) is an area that your physician should assess for infection or structural issues. The ET can produce fullness, autophia and cracking sounds with swallowing.  In our evaluation we assess the muscles that are important in controlling the opening and closing of the ET which may be the actual cause of the symptoms.

Treatment of ear symptoms may involve the following:

• Intra-oral treatment of the myofascial structures responsible for the referred pain is the key to treatment success. This is accomplished by resolving the nociceptive (painful) areas in the mastication muscles and muscles that influence the eustachian tube.   This process involves skilled techniques to access the muscles that are located deep in the mouth and soft palate.
• Performanc of manual therapy techniques to optimize joint mobility. This therapeutic application corrects any joint movement restrictions in the upper cervical and craniomandibular regions. This is accomplished by applying painfree mobilizations to the joints of the upper cervical spine and to the TMJ.
• Treatment of the cervical musculature is accomplished by a number of treatment concepts including reciprocal inhibition, ischemic compression and neuromuscular retraining.  
• Postural/Ergonomic education and training. Patient education and training on how to avoid mechanical stress on the cervical and TMJ regions is important.   It is well known that psychological stress may play a roll in the intensity of a patient’s  symptoms. There is a tendency to clench the teeth or contract the craniocervical muscles when under stress. This creates an “upregulated” (hypersensitive) neurological state, that can intensify the perception of ear symptoms especially  tinnitus.

If you require care for ear symptoms come to the experts at Rehabilitex.  We are innovating new treatments for this highly specialized course of treatment.  Click here to make an apppointment with one of our skilled PT's.